Healthcare Provider Details

I. General information

NPI: 1639459225
Provider Name (Legal Business Name): JOSHUA ADAM METZGER D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/26/2011
Last Update Date: 08/26/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

650 W BALTIMORE STREET 4TH FLOOR - PERIODONTICS DEPT
BALTIMORE MD
21201
US

IV. Provider business mailing address

650 W BALTIMORE STREET 4TH FLOOR - PERIODONTICS DEPT
BALTIMORE MD
21201
US

V. Phone/Fax

Practice location:
  • Phone: 410-706-7162
  • Fax: 410-706-7201
Mailing address:
  • Phone: 410-706-7162
  • Fax: 410-706-7201

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number15093
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: